Healthcare Provider Details

I. General information

NPI: 1295995991
Provider Name (Legal Business Name): NADINE ZIAD IDRISS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 WESTBARD CIR SUITE 3
BETHESDA MD
20816-1401
US

IV. Provider business mailing address

5301 WESTBARD CIR SUITE 3
BETHESDA MD
20816-1401
US

V. Phone/Fax

Practice location:
  • Phone: 301-654-6303
  • Fax: 301-654-6304
Mailing address:
  • Phone: 301-654-6303
  • Fax: 301-654-6304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0067948
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: